When many physicians think of lawsuits, the frivolous suit—a lawsuit that has no legal basis and is only meant to harass or extort money, according to Black’s Law Dictionary—may instantly come to mind. But reflexively discounting the merit of all lawsuits discounts the remarkable vehicles for social change they can become.
Let’s take a look at three health-care related lawsuits—from the past, recent past, and present—that were not frivolous, and not only changed history but benefited society.
Tuskegee Study class action: Between 1932 and 1972, the US Public Health Service, in cooperation with Tuskegee University and state and local health agencies, did what now, in the era of modern clinical research, would be unthinkable. They observed the natural progression of syphilis in poor African American sharecroppers and day laborers.
With offers of free medical checks, free food, free transportation, and burial insurance, 600 African American participants were lured into the Tuskegee Study of Untreated Syphilis in the Negro Male: 399 men with syphilis and 201 men without the disease. The men with syphilis were observed as they endured wounds, blindness, psychiatric disorders, and death. Although the men in the study received treatment for other diseases, they never received penicillin, which was introduced as a treatment for syphilis in 1947.
Victims of the Tuskegee Study—who never properly consented or were made cognizant of the risks of the study—were not told that they had syphilis. Instead, they were told they had “bad blood.” These men continued to have relationships with their sexual partners without knowing they were infected with the disease.
The Tuskegee Study finally ended in 1972 after the study went public, and consequently victims and their families received a $10 million settlement from the US government in a class-action suit. In 1997, President Bill Clinton formally apologized to any surviving victims. Nevertheless, any reparations far outweighed the repercussions of the study. Many experts feared the study would cause a chilling effect among African Americans, and lead to a distrust of the healthcare system.
So with all this negativity, where’s the upside? One major social change that occurred as a result of the Tuskegee Study was the 1976 publication of The Belmont Report, which stemmed from the National Research Act of 1974. This report consists of ethical guidelines for the treatment of human participants in research trials. In other words, no experiment like the Tuskegee Study will ever be conducted in the United States again.
Here is a description of The Belmont Report according to the Department of Health and Human Services:
“The Belmont Report was written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Commission, created as a result of the National Research Act of 1974, was charged with identifying the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and developing guidelines to assure that such research is conducted in accordance with those principles. Informed by monthly discussions that spanned nearly four years and an intensive four days of deliberation in 1976, the Commission published the Belmont Report, which identifies basic ethical principles and guidelines that address ethical issues arising from the conduct of research with human subjects.”
Liebeck v McDonald's Restaurants: In 1992, Stella Liebeck of Albuquerque, NM, was a passenger in her grandson’s car when she severely burned herself with a cup of McDonald’s coffee. The incident received a lot of media exposure and was heralded as an example of a frivolous lawsuit. But it wasn’t.
At the time of the incident, Liebeck was 79-years-old. When her grandson stopped so she could add cream and sugar to her coffee, which she had positioned between her legs, the coffee spilled onto her sweatpants. The sweatpants absorbed the hot liquid and clung to her thighs, buttocks, groin, and genital areas. She suffered third-degree burns and required debridement and skin grafts.
At first, Liebeck offered to settle for $20,000, but McDonald’s balked. During her trial, it was uncovered that hot coffee—served between 180° and 190°F—was a real problem for McDonald’s customers, with 700 corresponding lawsuits filed between 1982 and 1992.
Liebeck’s suit resulted in an initial verdict of $200,000 in compensatory damages and $2.7 million in punitive damages. The compensatory damages were later reduced because the jury found that Liebeck was at fault for 20% of the spill. But, the suit also resulted in McDonald’s lowering the temperature of their coffee to under 160°, which was more in line with other fast-food restaurants.
In recent years, Liebeck v McDonald's Restaurants has raised public consciousness of the value of tort and played an important role in debates over tort reform. The case was also featured prominently in a well-received 2011 documentary titled Hot Coffee.
UnitedHealthcare class action: For years, people have complained that health care insurers have been deficient and inconsistent in their coverage of psychotherapy and behavioral health services, despite federal and state laws requiring parity for behavioral health. In 2016, the US District Court for the Northern District of California certified two consolidated lawsuits against UnitedHealthcare, the largest managed behavioral health care organization in the United States.
The plaintiffs claimed that UnitedHealthcare pays only a fraction of psychotherapy costs based on the therapist’s credentials. This lawsuit was followed by several similar lawsuits against Cigna, Blue Cross, and Aetna. Verdicts in these lawsuits are expected to have huge ramifications for the burgeoning field of behavioral health and will help determine what is and isn’t covered.
Ultimately, as a physician, it may be tempting to support tort reform that limits litigation and financial damages. But remember, in some health care cases, tort reform legislature can help improve the world. Think about that the next time that you read about participants in a study, recommend psychotherapy, or even grab a (less) hot cup of McCafé coffee.